MARITIME TRANSPORT DEPARTMENT Under the management of SSOPCPL, CIN Number: U80904WB20190PC229658 Approved by Ministry of corporate affairs, Government of India Office address: SSOPCPL building, 8th floor, No- 818, collectors land, Haji katbela, Behramnagar, Bandra (E), Mumbai- 400051 Tel: 1800-1234-430 (Toll free) / 9569-46-8669, Website: www.mtdind.org comes ECR Email id: infomail@mtdind.org feedbackmail@mtdind.org Reference no: 21703/36452157954621854689, Date: 15/05/2021 To, The Principal / Headmaster, Institute name: NARAYANI HIGH SCHOOL Address: 5, Gamadia Colony, Dadhichi Road, Tardio, Mumbai, M/H - 400706 Sub: Verification of School Certificate Sir / Madam, Itis stated that Mr. / Miss_AVINASH KUMAR RAULKHENDE___ has been recruited by ‘our organization SSOPCPL at rank of Seafarer in department of Maritime transport. Hence, we request you to verify the mark sheet & certificate of Name of the course ‘Secondary Examination (Class-10) ] Examination year 2012 | Tt Certificate beating Sc eiaat SSE / 2012 / 12345678A Board oe ‘CENTRAL BOARD of SECONDARY EXAMINATION (C.B.S.E.) Photocopy of mark sheet have been attached. itis requested that the certificates may please be verified with your records and return the same duty mentioned with your remarks in separate letter for our further action. The report May kindly hand it over to him to the said personal. Encls: As above Thanking you. Yours faithfully, ‘* The Corporate Identity Number can be verified at the government's official website ‘© Verification time between 10.00 am to 04.00 pm, except for Saturday, Sunday & Government holiday.Ph. - (03223) 267292 Govt. Sponsord & Co-Educational DISE CODE - 19202404502 // Index No. -L5 - 044, H. S Code 205443 email: hmkhatikabmsc@gmail.co P.O. - KHARIKAMATHANI ve DIST - JHARGRAM ve PIN - 721159 Ref No. Date To, ‘Memo. No. KHLS/09/2020 SSOPCPL ates 06/02/20 ‘Sub: Study Verification of JIBAN HEMBRAM. a 3/12/2019, Sir, your letter Memo. No. SSOPCPI /19/01/37009015 dated | RAM, S/O In tesponse to { am glad to inform you the following information of JIBAN HEMB| Shyamal Hembram of Vill-Panchkahania , P.O. Morchi, P-S. Nayagram, Dist Jhargram who passed the Secondary Fxamination(M P.) in the year-2012 His (1)Date of birth as per admission register isto} 1996, 0405/2006. in Class-V having serial No.6 . (2)Date of admission (3)Year of leaving 2012, (@)Examination passed: M.P. Examination-2012 and {5)Character ofthe said student was good during the period of school days. Yours faithfully, . a rn 42|20 of verification report. * Sample co,MARITIME TRANSPORT DEPARTMENT Under the management of SSOPCPL, CIN Number: U80904WB20190PC229658 Approved by Ministry of corporate affairs, Government of India Office address: SSOPCPL building, 8th floor, No- 818, collectors land, Haji katbela, Behramnagar, Bandra (E), Mumbai- 400051 Tel: 1800-1234-430 (Toll free) / 9569-46-8669, Website: www mtdind.org CoAT TAC Email id: infomail@mtdind.org feedbackmail@mtdind.org Reference no: 21/03/95645972954625789456 Date: 15/05/2021 To, The ‘Superintendent of Police / Commissioner, Bandra East, Mumbai, _ Maharashtra - 400706 Sub: Character & Antecedents Verification Sir, Mr. | Mies __AVINASH KUMAR RAULKHENDE__ has been recruited by our organization SSOPCPL in department of Maritime transport service. On it's of off-shore location. Due to security reasons project department (Indian coastal shipping) do not allow any employee to deploy its personnel without their character and antecedents verification by the concerned Police headquarters. Hence, we request you to verify the character and antecedents of NAME AVINASH KUMAR RAULKHENDE FATHER'S NAME PRATIM KUMAR RAULKHENDE AS, Jain Marg, Matunga Street, Bandra East, Mumbai, M/H - 400706. ADDRESS CONTACT NO: 18001234430 The report May kindly hand it over to him to the said personal. Note: We require the character & Antecedents Verification etter of the above mention person photo duly stamp by the authorized signatory. Thanking you. Yours faithfully, ~ y, £ & car? cone ‘* The Corporate Identity Number can be verified at the government's official website «Verification time between 10.00 am to 04.00 pm, except for Saturday, Sunday & Government holiday.SAMPLE COPY Secret District Intelligence Branch, Coochbehar,the 05" Jan,2021. Memo.No. VR- 272(C)/2020 To ‘The Authorized Signatory SSOPCPL,Under the Management of SSOPCPL Approved by Ministry of Corporate Affairs, Govt. of India Ground Floor, Dkarampur Chowraha Bhagautiganj, Balarampur PIN-271201 Sub :- Character and Antecedents verification report of Joydeb Barman $/O Satyen Barman of Mathabahanga, Ward No.10, P.O. & PS. Mathabhanga, Dist. Cooch Behar, West Bengal . Ref :- No. SSOPCPL/20101/3701-0693 Dated- 15.10.2020. In reference to above this is to inform that during enquiry by the concern EO Sadar, Cooch Behar, it could be learnt that the above noted subject is permanent resident of above mentioned address has been verified. During enquiry nothing adverse found against him under Cooch Behar district. : i Aupdt.of Police, DIB, Coochbehar. of Police cup BeharModieal Certificate for Service at Se [Dseued under the Authority of Directorate General of Shipping, Govt of Inala under Rule 4 of M.S. (Medical Examination) Rules,2000 as amended) Pramanick Aviit (Seafarer Name: Last Firs, Indian Passport! CNC No, i ‘and has been found fit for service at sea inthe job of — A] o2o09 mate | bane ee ates agus —— x | say sence hhas been examined by Dr. Sanjiv Mukherjee, WB/KOLI04/2015 (NameotiedicalExaminer and approval no ) aang Valid unt Steward | Vision, are all satisfactory, and {Labour Convention 2008 2911/2019 ‘Kolkata, West Bengal, India. (Date & Piace of Medical Examination) | ke2011196262 (Serial number of the Certficate) "Adress: Eman (Day. Month, Year” [Net mere than 2 oar rom he detec sue, anes Ue sealer under ne age Of Tf Which case he BITE paid (2) The nearing and cight ofthe seeferec concerned, unre WOUT WSION Inne Case ofa seatarer to be employed in capacities where fitness forthe work io ae nevieemad i lable tobe afeced by defective colour (0) The seatarer complies with the requirements speciied in Table A/@ of STCW Cade (.e. Minimum in service {eyesight standards tor seafarers), Table B-V9 ofthe STCW Code (Le. Assessment of minimum erty level an i= service physical abities for seafarers) end Reguietion 1.2, Standard A-.2 & Guideline B. 1 nf he Marine Contact no | This Certcateeupes on zavtr20zt Oficial Stamp of he Medical Examine. (Signature of the Medical Fxaminer) Maritime Medical Consultancy 11/14, Manoharpukur Road, Kolkata-700026, | _____ West Benga, India. | (35 2415-2228 / 2186 / 2187 ‘m_m_c@maritimemedical.net of vality ofthe MatcalCeticate shalbe 1 ver! the card of valid fhe avin! erate epuesmtne aurea st ore he nent port of al her [ rgeecerenacece eee renewed medical certat Ror that Meical Examiner nore Mesa aes avatace an he Sealrer can get amines and ota sod nt exceding tree mors tlm the dle of xpi, koeSIGHT TEST GERTIFIOATE New Enty"?Perosier le UO Ful Name Aviary PRAMAS a _ STE Wnan PNAVIE SRE WREp TNAWIE econ AADRARR NOD 5933 644) Dew arieccctoim O2/0 JI9 (SRETIPUR) ee La __Conesveuey Rete Colour of Eyes entiation Nets A CUT MARK Rint FINGER Reghieye | Ueieye | someyes | Resa | Distance Vision nee é/é 676 C76 WORMAL | l ‘Aded KR RIB |_W/& ‘Near Vision aed NIé NI6 N16 HORA iene N/A NIA NA Field of Vision | Horizontal Plan ADEQUATE Vertical Pian T ADEQUATE Colour Vsion| Gig RORMAL Taniem 7 Others i |.Dr. Sanjiv Mukheriee hereby cert that the above mentioned candidate has metnet met’, the eye sight standard for hisiher designated rank / position as set cut in Annex-l* /Annex- I for seafaring ‘occupation D 2 Avia Gamaniey Se Candidate's Signature ‘Signature of the Medical Examiner pow 29/ Nf 2015 ot Ks engat ica Stamp Note: 1) This certficate is valid for two years from the above date. New entty sight test certificates should be retained by the candidate til his active sea career. 2) Seafarer aggrieved by the decision of the Medical Ext M.S. (Medical Examination) Rules, 2000 as amended, * Delete if not applicable, "Note: The principal rules were published in the Gazette of India, Part I, section 3, sub-section () vide ‘Notification Number G.S R87 (E) dated the 19” January, 2000, sseh— Ror caminer may appeal as per the provision of the hieREPORT OF MEDICAL EXAMINATION OF SCAFARER DY AN APPROVED MEDICAL EXAMINER. | per Merchant Shipping (Medial Feaminaticn) Riles, 2000 ad TSM/STEW cede 1/0 aad TA eanwention TA and MLC 2006 compliance Elite Nursing Home Approved by Decorate Genera of Shipping (Govt. of india) as per M.S Notce No.of 2015, No, WBLKOLOW/2015 TVA rr Road, Kolkata, 700026. India. Ph. (093) 2416-2186 2187, Fax. (033) 2419-2386 emai’ m.mo@maimemedicalnet Lo Sera No; —_REASTT INES Fist Name idle Neg a Indos Wo, : FANS "lank Steward Pe coc : sex: eo, Severe one-sided headaches (Nigrane) Head Injury / Concussion / Loss of Memory Fis / Enlepy / Dlzsnes / Fasting ye /Veion Problems (Glasses, te) ‘Rearog impatient Ear / Nose / Throat problems ‘Stomach / Bowel disorders Gallstones /Kdney disorders Jaundice / Ler Disease ies / Vancose vens ‘ood Dsorser Female Disorder Medical Examination Height _ Weight in Kos 162 cm BO Kgs Distant and Near Vision ight Eve Lett tye Other Fracture / Distocation / Iu / Amputation Major / Minor Operation Diabetes Nervous / Mental disease / Sleep dsorder KSKKRSISIC Kis) Field of Vision ead a neck @ | Respratoy stem ¥ Eyes | raiser eye 8 as / Nose / Throat 2 er Abdomen ¥ ie / Ui Lavy wi ‘Geno-unnary sysem ¥ erin Sear! system g E ‘Cac Inca Sytem g Nervous sytem ¥ emia / Hydrcoele ¥ ¥idg sureties y 7 Result Normal Urine Result usG Hemoglobin 13.3. gmt 13-16.9m% Calou ght Svan “ova WO cou ‘e200 usm 000-11000 / warm vue ‘30 mi New Gi iymp 33 % Fos 3 % Ba OO % Mo O1 % | Soecifc Grviy 1019 40% 6.0% oe ‘Acidic 23st 19. ctu te wt SU /L Sugar ‘Nil UL 8-401 __ Be sats NL ‘special investigation aun, ‘2e- 200MA, ‘Bsns nit ‘ody Mass index (BMD : a eetene ‘mala ‘oto 200 ma fl mn: 19.0 vr Permanently uv Should be reexamined it cep i MEDICALLY FIT" 1, Dr: San Mukherjee, erty that al information required wader Annexure ER F Candidate's Signature Certificate valia ti :| 28/12/2021. "5. (Medical amination) Rules 2000 % Incorporated inthis cetiat SsrnedSiratee Ograenedaeie Issued On: 28/11/2019 eg. Noa Doctor's siguture